This study is an evaluation of the effectiveness of institution-wide policy changes and efforts to promote safety measures, known to be efficacious for reducing the risk of percutaneous blood and body fluid exposures (BBFE), among operating room (OR) personnel at Duke University Hospital (DUH). The intervention efforts, implemented between July 2005 and January 2007, include NIOSH-recommended evidence-based safety practices: double-gloving, the use of blunt suture needles and "hands-free techniques" for passing surgical instruments during operations. A mixed-method (quantitative and qualitative) study design will be used to achieve the Specific Aims which include 1) enhancing our understanding of BBFE risk factors for individuals and surgical procedures, 2) evaluating the impact of the policy changes on the risk of BBFE in the OR and 3) assessing the adoption of these measures, and reasons for non-adoption, among surgical staff. The proposed work addresses the prevention of one of the more common and potentially serious injury hazards among surgical staff. This evaluative study builds directly on preliminary data analyses of BBFE among OR personnel at DUH and an ongoing comprehensive surveillance effort that will provide the data to conduct the largest ever investigation of risk of BBFE in the OR environment. The Principal Investigator (PI) will be guided by a team of mentors that includes senior faculty members in the Division of Occupational and Environmental Medicine who have extensive experience in surveillance and injury epidemiology, a faculty member in the Sociology Department who is an expert on social group dynamics and qualitative methods and a faculty member and practicing surgeon from the Orthopaedic Surgery Department. In addition to using epidemiologic methods, this innovative research will provide the PI with the opportunity to incorporate sociological perspectives and social network methods into occupational epidemiology in order to explore new approaches to the etiology of BBFE in the OR and to develop new ways to increase the adoption of recommended safety practices. This research will provide learning experiences for the PI that will build upon and advance his prior work which has demonstrated the utility of social network methods for studying injury risk among healthcare workers. A central learning objective is to improve the Pi's ability to utilize his training in sociology in a way that is useful for occupational health research.